- Title
- Effect of Outcome Measures on the Apparent Efficacy of Ablation for Atrial Fibrillation: Why “Success” is an Inappropriate Term
- Creator
- Jackson, Nicholas; Mahmoodi, Ehsan; Leitch, Jim; Barlow, Malcolm; Davies, Allan; Collins, Nicholas; Leigh, Lucy; Oldmeadow, Christopher; Boyle, Andrew
- Relation
- Heart Lung and Circulation Vol. 30, Issue 8, p. 1166-1173
- Publisher Link
- http://dx.doi.org/10.1016/j.hlc.2021.01.013
- Publisher
- Elsevier
- Resource Type
- journal article
- Date
- 2021
- Description
- Introduction: Different endpoint criteria, different durations of follow-up and the completeness of follow-up can dramatically affect the perceived benefits of atrial fibrillation (AF) ablation. Methods: We defined three endpoints for recurrence of AF post ablation in a cohort of 200 patients with symptomatic AF, refractory to antiarrhythmic drugs (AADs). A ‘Strict Endpoint’ where patients were considered to have a recurrence with any symptomatic or documented recurrence for ≥30 seconds with no blanking period, and off their AADs, a ‘Liberal Endpoint’ where only documented recurrences after the blanking period, either on or off AADs were counted, and a ‘Patient-defined Outcome endpoint’ which was the same as the Liberal endpoint but allowed for up to two recurrences and one repeat ablation or DCCV during follow-up. We also surveyed 50 patients on the waiting list for an AF ablation and asked them key questions regarding what they would consider to be a successful result for them. Results: Freedom from recurrence of atrial tachyarrhythmias (AT) at 5 years was 62% for the Strict Endpoint, 73% for the Liberal Endpoint, and 80% for the Patient-defined Outcome endpoint (p<0.001). Of the 50 patients surveyed awaiting AF ablation, 70% said they would still consider the procedure a success if it required one repeat ablation or one DCCV (p=0.004), and 76% would be accepting of one or two recurrences during follow-up (p<0.001). Conclusion: In this study, the majority of patients still considered AF ablation a successful treatment if they had up to two recurrences of AF, one repeat procedure or one DCCV. Furthermore, a ‘Patient-defined’ definition of success lead to significantly different results in this AF ablation cohort when compared to conventionally used/guideline directed measures of success.
- Subject
- atrial fibrillation; AF ablation; outcome; success
- Identifier
- http://hdl.handle.net/1959.13/1474772
- Identifier
- uon:49366
- Identifier
- ISSN:1443-9506
- Language
- eng
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